Thursday, July 01, 2010

The Pool's Open!

It's summertime and the government's high risk insurance pool (made available by the recent passage of the health care reform bill ironically called the "Patient Protection and Affordable Care Act") opens today. Uninsurable people should jump on in if they can "afford" the hefty $400-$900 cost per month. Be sure to bring the whole family so they can help pay the bill, too!

While the need for the uninsured to obtain insurance exists, the opening of this insurance "pool" provides another stark reminder of how the health care reform bill was railroaded through Congress with waves of magic wands and unrealistics promises of cost controls:

The biggest question hanging over the program is whether the $5 billion allocated will be enough.

Millions of people meet the basic qualifications for coverage, and technical experts who advise Congress and the administration have warned the funds could be exhausted as early as the end of 2011.

HHS officials sidestepped questions about what would happen if the money runs out. One option is for the government to limit enrollment. (Emphasis mine.)

Popper estimated about 200,000 people would be enrolled in the program at any one time, but other HHS experts estimated that 375,000 would sign up this year, and the Congressional Budget Office says the total could reach 700,000 in 2013.

Oh, and one more thing. That low price quoted above for monthly premiums? That doesn't include the $5000 deductible you'll have to pay to get that low price in Illinois. Not happy with this? You can find your rate at Illinois' Premium Rate Calculator.

5 comments:

Why does the medical profession always blame the government for not having enough money to finance health care for all Americans? Why don't they quit bellyaching and start reducing system excesses they create to build their own wealth while they have fun playing with expensive experimental technologies and receiving kickbacks from big drug/medical technology companies? What? Make hospitals efficient too? Guess what's coming next doc? Regulation you won't want! YOU will make it inevitable. So step up to the plate and do what is right. Imagine,the AMA takes a leading role in cleaning up American health care! Might get sued less if ya did!

Why does the medical profession always blame the government for not having enough money to finance health care for all Americans?

I do not think that it does. Many doctors would prefer to have the government out of the health care business entirely.

Why don't they quit bellyaching and start reducing system excesses they create to build their own wealth while they have fun playing with expensive experimental technologies and receiving kickbacks from big drug/medical technology companies?

You are confused. Much of the waste comes from regulations and the need to practice defensive medicine. If the system were competitive costs would fall and health care would be more affordable. Sadly, that can't happen until government steps aside.

What? Make hospitals efficient too? Guess what's coming next doc? Regulation you won't want! YOU will make it inevitable.

I have news for you. The health care system is highly regulated. That is the primary reason why health care is so expensive.

So step up to the plate and do what is right.

What is right is exchanging one's services to those willing to pay for them.

Imagine,the AMA takes a leading role in cleaning up American health care! Might get sued less if ya did!

No chance. Lawsuits are a national past time in the US. The system is set up to rob from producers and transfer their wealth to the lawyers.

Not confused at all. Yes physicians are completely and unfairly overburdened with the most complex billing and reimbursement scheme on the planet. I feel terrible every time I have to contact my 80 year old mother's physician to re-order a prescription from a medicare contracted pharmacy. It is the most absurd system anyone could have ever devised. Physicians are amazing, truly blessed, intelligent and one of the most gifted group of individuals on the planet. I have enormous respect and admiration for what they do and have to endure on a daily basis. But someone has to pay for your work, and someone has to set the standards so that fair and equitable distibution of limited resources are properly managed. Someone has to ensure quality, safe delivery of services. It goes so far beyond the physicians'office practice. Who stopped a Maryland physician from placing caronary artery stents into 585+ patients who did not need them? KevinMD blog had some good thoughts on this. Who stopped the surgeon from operating on a injured patient's wrist 15 times after placing his own non-FDA approved articifical wrist in his own outpatient surgery facility? Who stops the gastric bypass surgeon from operating on individuals who are psychologically impaired and unable to stop eating? Who says there is no benefit to a certain technology before hospitals invest in it? Who stands up and fights for one national billing system for all payors that will be user friendly for all - patient and physician included? I truly WANT the medical profession to do it all, lead the way, not the government. But it hasn't happened...yet. I only hear physicians complaining. I was uanble to find a physician in north Atanta who would accept a new Medicare patient and if they took my 80 year old mother, she would have to do her own billing and pay upfront out of pocket. I called 15 physicians. What cowards. How many peer review committees do I have to sit through where the majority of physician members come 10 minutes late and leave 10 minutes early for their 1 hour monthly meeting ? How many surgeons bring in their own devices to the OR to experiment on with the company rep present without the hospital knowing it? Without hospital biomedical engineerig even testing to make sure it is safe? Who stopped the neurosurgeon from altering a brain surgery device against manufacturer specifications to suit his own needs and using it on a patient? No physician did. No hospital employee did. No government regulation did.No I am not confused at all. I live it every day. I believe in physicians and their great talents and gifts. I won't stop believing in them. So many, many good ones out there. Just waiting for strong impassioned directed leadership to emerge from their collective strength. Medicine must not only be practiced, it must be managed.

I feel terrible every time I have to contact my 80 year old mother's physician to re-order a prescription from a medicare contracted pharmacy. It is the most absurd system anyone could have ever devised.

That is what happens when government gets to call the shots. A lot of useless paperwork becomes 'essential' and resources are diverted away the delivery of services.

Physicians are amazing, truly blessed, intelligent and one of the most gifted group of individuals on the planet. I have enormous respect and admiration for what they do and have to endure on a daily basis.

Frankly, most physicians may be smart but what they do most of the day can be done by a nurse if she were permitted to. Because the AMA funnels all services through the GP the system is not nearly as effective as it should be.

But someone has to pay for your work, and someone has to set the standards so that fair and equitable distibution of limited resources are properly managed.

I agree. That someone should be the consumer who has a choice as the government steps aside and lets patients and providers control the process.

Someone has to ensure quality, safe delivery of services. It goes so far beyond the physicians'office practice.

Nonsense. No regulatory body controls the quality of TV sets, computers, phones, etc., and the products that we get have improved greatly.

Who stopped a Maryland physician from placing caronary artery stents into 585+ patients who did not need them?

It was not the regulators who are supposed to protect patients. Actually, the regulators provide cover for physicians out to make a buck without regard for their patients. The regulatory process creates information and activity monopolies which limit choice. if you want to protect patients you need to ensure that they have a great deal more choice than they do and that third party payment schemes are phased out as quickly as possible.

Who stopped the surgeon from operating on a injured patient's wrist 15 times after placing his own non-FDA approved articifical wrist in his own outpatient surgery facility? Who stops the gastric bypass surgeon from operating on individuals who are psychologically impaired and unable to stop eating?

Not the regulators, who failed in their job. And not the AMA, which controls competition and by doing so ensures that incompetent and unscrupulous doctors remain on the job without much worry.

I believe in physicians and their great talents and gifts. I won't stop believing in them. So many, many good ones out there. Just waiting for strong impassioned directed leadership to emerge from their collective strength.

Medicine must not only be practiced, it must be managed.

You can't manage human nature. The only way to get effective health care is to permit competition by getting the government out of the health care business and to give consumers choices. Competition certainly works well for the distribution of food, clothing, shelter, and other 'essentials.' On the other hand, the managed competition approach that you prefer has caused failures in education, health care, postal delivery, etc. Your preferences to manage health care are clearly inconsistent with your examples that show that such management has failed patients and providers.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.